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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 06/16/2025
Date Signed: 06/16/2025 12:54:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/26/2024 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20240326115522
FACILITY NAME:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR:STEPHANIE JUKICFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:328CENSUS: DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sara ModugnoTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility call system is not operational
Facility staff failed to provide adequate care and supervision to a resident in order to prevent the occurrence of falls.
Facility is not providing adequate toileting care to a resident.

INVESTIGATION FINDINGS:
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On June 16, 2025, Licensing Program Analyst (LPA) Samer Haddadin met with Executive Director (ED) Sara Modugno to deliver the findings regarding a complaint filed on March 26, 2024. The investigation involved a review of facility records, staff and resident interviews, and direct observation.
II. Allegations Investigated
The Department received a complaint on March 26, 2024, which contained several allegations. The complaint alleged that the facility's call system was not operational, that staff failed to provide adequate care and supervision to a resident to prevent falls, and that the facility was not providing adequate toileting care to a resident.
III. Investigative Findings
Regarding the allegation that the facility's call system is not operational, the LPA reviewed records for three separate resident calls made using a pendant button, which indicated the system was functional. Furthermore, on June 16, 2025, the LPA and the ED tested the system directly.{**CONTINUE9099C**}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20240326115522
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 06/16/2025
NARRATIVE
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A test of two separate resident pendants resulted in response times of 26 seconds and 15 seconds, respectively. A test of a call button in a restroom showed a response time of one minute and 55 seconds. These findings confirm the call system is operational.
In response to the allegation that staff failed to provide adequate care and supervision to prevent falls, the LPA reviewed the file for Resident 1 (R1), who has been identified as a fall risk. The review confirmed R1 had three falls without injury in February 2024. After each incident, the facility placed R1 on a 72-hour observation watch, consistent with its policy. Records also showed that on April 11, 2024, management met with R1's Power of Attorney (POA) to propose one-on-one caregiver services, which the POA declined. Interviews with four staff members corroborated the facility's protocol for responding to resident falls.
Concerning the allegation that the facility is not providing adequate toileting care, interviews were conducted with four staff members, all of whom denied the claim. Additionally, during a facility tour on June 16, 2025, the LPA personally observed two caregivers appropriately responding to a resident's incontinence care needs.
IV. Conclusion
Based on the observations, record reviews, and interviews conducted, the Licensing Program Analyst was unable to find a preponderance of evidence to validate the allegations. While it is possible the alleged events occurred, the investigation could not produce sufficient evidence to prove that a violation of licensing regulations took place.
Therefore, the allegations are deemed UNSUBSTANTIATED.
V. Exit Interview
An exit interview was conducted with Executive Director Sara Modugno. A copy of this report was provided to her at the conclusion of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
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